Hemoperitoneum Secondary to Spontaneous Rupture of a Retroperitoneal Varix

Abstract

Hemoperitoneum due to a ruptured retroperitoneal varix is an exceedingly rare condition and a poor prognostic sign with catastrophic and life-threatening complication of portal hypertension. We present a unique case of a 56-year-old female with cirrhosis secondary to primary sclerosing cholangitis who presented with acute abdominal pain and hypovolemic shock prior to a cardiac arrest following a ruptured retroperitoneal varix without prior esophageal varices and a newly identified intrahepatic cholangiocarcinoma. The clinical presentation with abdominal pain and hemorrhagic shock is consistently reported in the relevant literature. Early recognition affords appropriate management and urgent surgical intervention leading to survival.

Hemoperitoneum From Bleeding Intra-Abdominal Varices: A Rare, Life-Threatening Cause of Abdominal Pain in a Patient With Cirrhosis

“…In a literature review of published cases, we identified eight previous case reports of hemoperitoneum in the setting of bleeding ectopic abdominal varices [3,[20][21][22][23][24][25][26]. Four patients underwent exploratory laparotomy with ligation with 100% mortality [21,[24][25]. One patient was initially diagnosed with bleeding from esophageal varices and underwent successful emergent TIPS placement.…”